Get Application 2010 0004c Aemt Application - Department Of Health

This guide provides clear instructions on how to carefully complete the Application 2010 0004C AEMT Application for the Department of Health. By following these steps, you can ensure that your application process runs smoothly.

Follow the steps to successfully fill out your application

1. Click ‘Get Form’ button to obtain the application and open it in the editor.
2. Begin by selecting the appropriate type of application you are submitting: Initial Certification, Renewal of Certification, Reciprocity Application, or Reinstatement.
3. Fill out your personal information, including your last name, first name, middle initial, other names used, and social security number. Also include your gender, birth date, and contact details.
4. Provide the name of your sponsoring EMS agency. Remember, it's essential that this agency signs the application to verify your membership.
5. In the 'Required Certifications' section, input your NREMT level, certification number, and expiration date. Ensure that a copy of your NREMT certification and CPR certification are attached.
6. List all your work experience as an EMS provider for the past ten years, including start and end dates for each position.
7. Address any previous health professional licenses or certifications by answering 'Yes' or 'No' to the relevant questions and provide detailed information if applicable.
8. If applicable, provide information regarding any criminal history, outstanding debts, or previous disciplinary actions against any professional licenses.
9. Review your application for accuracy. You will need to sign and date the application, certifying that the information is complete and truthful.
10. Ensure the signature of your Physician Medical Director is included, confirming your status as a member of their organization.
11. Submit the completed application with the required documentation to the Department of Health, along with the appropriate application fee.
12. Once submitted, keep a copy of your application and any supporting documents for your records. You may also inquire about your application's status through your sponsoring EMS agency.

Complete your AEMT application online today and take the next step in your career.